Remote Psychologist Behavioral Health Utilization Reviewer

UnitedHealth Group; Denver (CO); Remote; Full time

Job summary

Join a major healthcare organization as a Psychologist Peer Reviewer where you will make critical clinical evaluations and determinations to influence patient care. With a focus on improving health outcomes, you will engage in peer consultations and ensure compliance with guidelines while enjoying the flexibility of remote work within the U.S. This role provides opportunities for career growth, backed by a supportive and inclusive culture.

Benefits

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401(k) contribution

Qualifications

• Licensed doctoral level Psychologist in state of residence.
• 3+ years of post-licensure experience required.
• Experience working with insurance agencies preferred.

Responsibilities

• Conduct clinical reviews and benefit determinations.
• Participate in peer consultations and trainings.
• Review outpatient treatment plans and appeals.

Skills

Clinical Evaluation

Psychological Testing

Communication

Computer Skills

Education

Licensed doctoral level (Ph.D. or Psy.D.)

Tools

Windows OS

Excel

Outlook

Word

Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The role of the Psychologist Peer Review involves applying clinical criteria and benefit plan requirements to Commercial, Medicaid, and Medicare cases, and making clinical and / or benefit determinations to continue coverage of treatment, shaping and modifying treatment as appropriate, or issuing an adverse benefit determination if applicable criteria is not met.

You’ll enjoy the flexibility to work remotely

• from anywhere within the U.S. as you take on some tough challenges. Schedule is Monday - Friday, standard business hours.

Primary Responsibilities :

Psychological / Neuropsychological Testing service requests

Standard outpatient treatment, including requests for extended length sessions or single case agreements

State - specific Medicaid services (e.g. Psychosocial Rehabilitation, Targeted Case Management, Home Based Habilitation, Supported Employment, etc.)

Intensive Outpatient services for both Mental Health and Substance Abuse

The Psychologist Reviewer will also participate in peer consultations, staff meetings, and trainings; be responsible for entering determinations within federal, state, and local guideline requirements; and perform of other duties as required by the reviewer’s manager

The Psychologist may conduct Non-MD clinical reviews of the following type during a typical workday : Requests for psychological or neuropsychological testing

Review of outpatient treatment plans for services that are sent for Peer Review that do not appear to meet clinical criteria and / or when there are concerns about the quality of care

Review of ongoing outpatient care in cases where the member’s treatment episode exceeds normative standards

Requests for non - standard outpatient services (extended - length visits, an in - network accommodation, intensive outpatient program with no MD involvement)

Appeals of previously denied services or claims for outpatient Non - MD services up to and including Intensive Outpatient Programming

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications :

• Licensed doctoral level (Ph.D. or Psy.D.) Psychologist in your state of residence
• Current License, allow for full independent practice, and be unrestricted (you may be asked to obtain additional state licenses to meet growing business needs)
• 3+ years of post - licensure experience
• Experience working with insurance agencies
• Computer skills, including facility with Windows OS, Outlook, Word, and Excel
• Ability to type proficiently while speaking on the phone

Preferred Qualifications :

• Experience working in a managed care setting
• Experience performing Peer Reviews
• Experience with commercial, Medicaid and Medicare lines of business
• Experience with CPT and HCPC codes
• Clinical experience in higher levels of care (Intensive Outpatient)
• Clinical experience with children and adolescents
• Clinical experience with Substance Abuse diagnoses
• Clinical experience with Evidence-Based Treatment
• Advanced computer skills using Excel and Access Databases
• Experience with Psychological / Neuropsychological Testing service requests
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

The salary range for this role is $89, to $, annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Application Deadline : This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.